Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Four Year Trend of Carbapenem-Resistance in Newly Opened ICUs of a University-Affiliated Hospital of South Korea

  • Kim, Bo-Min (Division of Pulmonary and Allergy, Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Jeon, Eun-Ju (Division of Pulmonary and Allergy, Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Jang, Ju-Young (Division of Pulmonary and Allergy, Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Chung, Jin-Won (Division of Pulmonary and Allergy, Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Park, Ji-Hoon (Division of Pulmonary and Allergy, Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Choi, Jae-Chol (Division of Pulmonary and Allergy, Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Shin, Jong-Wook (Division of Pulmonary and Allergy, Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Park, In-Won (Division of Pulmonary and Allergy, Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Choi, Byoung-Whui (Division of Pulmonary and Allergy, Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Kim, Jae-Yeol (Division of Pulmonary and Allergy, Department of Internal Medicine, Chung-Ang University College of Medicine)
  • Received : 2011.12.01
  • Accepted : 2012.03.15
  • Published : 2012.04.30
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Abstract

Background: Carbapenem-resistance is rapidly evolving among the pathogenic microbes in intensive care units (ICUs). This study aimed to determine annual trend of carbapenem-resistance in the ICU for 4 years, since the opening of a university-affiliated hospital in South Korea. Methods: From 2005 to 2008, microbial samples from consecutive 6,772 patients were screened in the ICU. Three hundred and ninety-seven patients (5.9%) and their first isolates of carbapenem-resistant pathogens were analyzed. Results: The percentage of patients infected with carbapenem-resistant organisms increased constantly during the initial three years (2.3% in 2005, 6.2% in 2006, 7.8% in 2007), then it declined to 6.5% in 2008. Acute Physiology and Chronic Health Evaluation (APACHE) III score at admission was $58.0{\pm}23.5$, the median length of the ICU stay was 37 days, and the mortality rate was 37.5%. The sampling sites were endotracheal suction (67%), catheterized urine (17%), wound (6%) and others (10%). Bacteria with carbapenem-resistance were Pseudomonas aeruginosa (247 isolates, 62%), Acinetobacter baumannii (117 isolates, 30%), Enterobacteriaceae (12 isolates, 3%), and others (21, 5%). Of note, peak isolation of carbapenem-resistant microorganisms in medical ICU was followed by the same epidemic at surgical ICU. Conclusion: Taken together, carbapenem-resistant pathogens are of growing concern in the ICU.

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References

  1. Gaynes R, Edwards JR; National Nosocomial Infections Surveillance System. Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 2005;41:848-54. https://doi.org/10.1086/432803
  2. Song JH. Current status and future strategies of antimicrobial resistance in Korea. Korean J Med 2009;77: 143-51.
  3. Neuhauser MM, Weinstein RA, Rydman R, Danziger LH, Karam G, Quinn JP. Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use. JAMA 2003;289: 885-8. https://doi.org/10.1001/jama.289.7.885
  4. Paterson DL, Ko WC, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, et al. Antibiotic therapy for Klebsiella pneumoniae bacteremia: implications of production of extended-spectrum beta-lactamases. Clin Infect Dis 2004;39:31-7. https://doi.org/10.1086/420816
  5. Lee K, Lee HS, Jang SJ, Park AJ, Lee MH, Song WK, et al. Antimicrobial resistance surveillance of bacteria in 1999 in Korea with a special reference to resistance of enterococci to vancomycin and gram-negative bacilli to third generation cephalosporin, imipenem, and fluoroquinolone. J Korean Med Sci 2001;16:262-70. https://doi.org/10.3346/jkms.2001.16.3.262
  6. Dubois V, Arpin C, Melon M, Melon B, Andre C, Frigo C, et al. Nosocomial outbreak due to a multiresistant strain of Pseudomonas aeruginosa P12: efficacy of cefepime- amikacin therapy and analysis of beta-lactam resistance. J Clin Microbiol 2001;39:2072-8. https://doi.org/10.1128/JCM.39.6.2072-2078.2001
  7. Rhomberg PR, Jones RN. Contemporary activity of meropenem and comparator broad-spectrum agents: MYSTIC program report from the United States component (2005). Diagn Microbiol Infect Dis 2007;57:207-15. https://doi.org/10.1016/j.diagmicrobio.2006.07.009
  8. Agodi A, Zarrilli R, Barchitta M, Anzaldi A, Di Popolo A, Mattaliano A, et al. Alert surveillance of intensive care unit-acquired Acinetobacter infections in a Sicilian hospital. Clin Microbiol Infect 2006;12:241-7. https://doi.org/10.1111/j.1469-0691.2005.01339.x
  9. Winokur PL, Canton R, Casellas JM, Legakis N. Variations in the prevalence of strains expressing an extended-spectrum beta-lactamase phenotype and characterization of isolates from Europe, the Americas, and the Western Pacific region. Clin Infect Dis 2001;32 Suppl 2:S94-103.
  10. World Health Organization. WHO Collaborating Centre for Drug Statistics Methodology [Internet]. Oslo: WHO; 2011 [cited 2011 Dec 1]. Available from: http://www.whocc.no/atcddd/.
  11. Norrby SR. Carbapenems. Med Clin North Am 1995; 79:745-59. https://doi.org/10.1016/S0025-7125(16)30037-2
  12. Brown S, Amyes S. OXA (beta)-lactamases in Acinetobacter: the story so far. J Antimicrob Chemother 2006;57:1-3. https://doi.org/10.1093/jac/dki425
  13. Lortholary O, Fagon JY, Hoi AB, Slama MA, Pierre J, Giral P, et al. Nosocomial acquisition of multiresistant Acinetobacter baumannii : risk factors and prognosis. Clin Infect Dis 1995;20:790-6. https://doi.org/10.1093/clinids/20.4.790
  14. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887-92. https://doi.org/10.1097/00003246-199905000-00020
  15. Crespo MP, Woodford N, Sinclair A, Kaufmann ME, Turton J, Glover J, et al. Outbreak of carbapenem-resistant Pseudomonas aeruginosa producing VIM-8, a novel metallo-beta-lactamase, in a tertiary care center in Cali, Colombia. J Clin Microbiol 2004;42:5094-101. https://doi.org/10.1128/JCM.42.11.5094-5101.2004
  16. Agarwal R, Gupta D, Ray P, Aggarwal AN, Jindal SK. Epidemiology, risk factors and outcome of nosocomial infections in a Respiratory Intensive Care Unit in North India. J Infect 2006;53:98-105. https://doi.org/10.1016/j.jinf.2005.10.021
  17. Pournaras S, Markogiannakis A, Ikonomidis A, Kondyli L, Bethimouti K, Maniatis AN, et al. Outbreak of multiple clones of imipenem-resistant Acinetobacter baumannii isolates expressing OXA-58 carbapenemase in an intensive care unit. J Antimicrob Chemother 2006; 57:557-61. https://doi.org/10.1093/jac/dkl004
  18. Koeleman JG, Parlevliet GA, Dijkshoorn L, Savelkoul PH, Vandenbroucke-Grauls CM. Nosocomial outbreak of multi-resistant Acinetobacter baumannii on a surgical ward: epidemiology and risk factors for acquisition. J Hosp Infect 1997;37:113-23. https://doi.org/10.1016/S0195-6701(97)90181-X

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